Despite the recognition of cardiovascular disease (CVD) as a leading cause of mortality, this country lacks a cohesive, informative surveillance system that can provide insights into national patterns of care, reveal national trends over time, and track short- and long-term patient outcomes for elderly Americans. Most national estimates of CVD and outcomes have been based on extrapolating rates from a very small number of community studies or clinical studies that are restricted in terms of size, demographics, or geography. In addition, outcome measures have most often been limited to recurrent disease or death, and typically consider short-term outcomes (rarely beyond 12 to 24 months). Related vascular events and nonvascular events are rarely considered. This has resulted in significant data gaps. Defining patterns and trends of CVD, and identifying differences and disparities among diverse groups in terms of age, race, gender, clinical history, as well as different geographic regions of the United States should be a top research priority. We have created a population-based national cohort that will begin to fill these gaps in knowledge. The Cardiovascular Disease Trends in the Elderly Study will span 12 years and include all fee-for-service Medicare beneficiaries discharged with CVD from 1991 through 2003. Accordingly, this study has the following specific aims: (1) Determine 12-year cardiovascular disease trends, especially by age, race, and gender subgroups, as well as region; (2) determine the short- and long-term outcomes for patients hospitalized with cardiovascular disease; and (3) determine the change in cost and outcomes for Medicare beneficiaries. This career development award will enable the candidate to build additional skills to link the complementary disciplines of clinical medicine, epidemiology, public health, biostatistics, and health economics to examine the burden of cardiovascular disease in the elderly. This unique perspective will provide valuable insights for policy makers and investigators in planning for the health care needs of patients with established cardiovascular disease.